Objective: To investigate the effects of different surgical methods on the long-term prognosis of patients with stage IV gallbladder carcinoma. Methods: The clinical and follow-up data of 134 patients with stage IV gallbladder carcinoma undergoing surgical treatment were retrospectively analyzed. Of the patients, 44 cases underwent palliative resection (palliative surgery group), 56 cases received radical or extended radical treatment for gallbladder carcinoma (radical surgery group), and 34 cases only had internal and external biliary drainage (drainage group). The long-term results among the three groups of patients were compared. Results: For patients with stage IVa gallbladder carcinoma, there was no statistical difference among the three groups in postoperative 1-year survival rate (P>0.05), but the postoperative 3-year survival rate in radical surgery group was significantly higher than that in palliative surgery group or drainage group (17.2% vs. 0.0% vs. 0.0%, both P<0.05). The median postoperative survival time in radical surgery group was 18 months, which was significantly longer than that in palliative surgery group (14 months) and drainage group (12 months) (χ2=12.094; 14.876, both P<0.05). For patients with stage IVb gallbladder carcinoma, both postoperative 1- and 3-year survival rates showed no statistical difference among the three groups (both P>0.05); the median postoperative survival time in radical surgery group was 14 months that was significantly longer than that in palliative surgery group (9 months) and drainage group (9 months) (χ2=8.741; 8.839, both P<0.05). Conclusion: Early radical resection may be helpful for improving the long-term outcomes of patients with stage IV gallbladder carcinoma.